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Biomedical subjects

J Llorca

Publications and source records attributed to J Llorca.

At least 37 records · Page 2Linked to original sources

[Role of primary care teams in hospitalization of children under 2 years of age?].

OBJECTIVE: To determine whether the structure of primary care teams on carrying out the healthy child health programme leads to a drop in the risk of admission to hospital of children under two, in comparison with the traditional clinic or out-clinic health system. DESIGN: Case-reference epidemiological study. CASES: 40% of the children under 24 months admitted to paediatric or neonate floors of the Marqués de Valdecilla University Hospital. Reference: 15% of the recently born children alive in this hospital. Information was gathered through face-to-face interview and by examining health cards. The study ran from April 1995 to May 1996. RESULTS: Children under two monitored habitually by a doctor belonging to a primary care team showed a drop in risk of hospital admission for all clinical diagnoses of 0.57 (95% CI, 0.35-0.93), after adjustment due to various confusion factors such as maternal education, social class, ethnic background, mother's age, mother's tobacco consumption, natural breast-feeding at birth, admission at birth. There was a drop of risk of hospital admission for high temperature without apparent cause in those children monitored habitually by a team doctor (adjusted RR = 0.41; 95% CI, 0.19-0.90). CONCLUSIONS: The advantages of the paediatric health care reform with the structuring of the primary care teams and the accompanying activities performed lead to a drop in the risk of hospital admission of those children under two years old who are habitually monitored by a doctor belonging to a primary care team.

Female↗

Polymorphism at codon 129 of the prion protein gene is not associated with sporadic AD.

An association between cognitive performance in elderly people and variability in the codon 129 of the prion protein gene (PRNP) has been recently described. The authors analyzed this polymorphism in 278 sporadic AD patients and 268 cognitively normal control subjects. Analyses stratifying by APOE genotype, age, and gender failed to reveal any association between homozygosity for the 129 PRNP methionine or valine alleles and AD.

Age of Onset↗

A comparison of several procedures to estimate the confidence interval for attributable risk in case-control studies.

The estimation of a confidence interval for attributable risk from the logistic model based on data from case-control studies is a problem for which an accepted solution is lacking. Two methods, one based on the delta method and one bootstrap on the population base, have been described but their accuracy has not been compared. We present two other methods, one based on a jack-knife approach and the other using a bootstrap on two samples (cases and controls). The four methods are compared in a simulation study. The four methods are also applied to a case-control study on risk factors for preterm delivery; the confidence intervals are obtained assuming normality and by logarithmic transformation. When attributable risk is not smooth (for example, when exposure prevalence is low) both the jack-knife and the delta method tend to fail. If attributable risk is close to zero or one, normality cannot be assumed and log-transformed confidence intervals must be used. Finally, the extension to matched studies is analysed using a case-control study on risk factors of cutaneous malignant melanoma. In this situation, the population-based bootstrap is not available.

Abruptio Placentae↗

[Pre and perioperative factors determining early in-hospital mortality in patients over 75 years of age undergoing cardiac surgery].

INTRODUCTION AND OBJECTIVES: To know the in-hospital morbidity and mortality and the related factors in patients over 75 years old undergoing cardiac surgery. PATIENTS AND METHODS: A retrospective analysis was carried out in 252 out of 2043 consecutive patients (129 female, 123 male) over 75 years of age (mean age 77.8 years; range 75 to 89 years) undergoing open heart surgery from january 1, 1994 to november 30, 1997. Isolated aortic valve replacement was performed in 128 patients, 78 underwent isolated coronary artery bypass grafting and 46 combined surgery. Preoperative determinants of morbidity and mortality were analyzed. RESULTS: The overall hospital mortality was 15.1%, 13.2% in the aortic group, 12.8% in the coronary group and 23.9% in the combined surgery group. The overall morbidity rate was 38.6% and 25.8%, 34.2% in the aortic and coronary groups, respectively. Preoperative risk factors were prior surgery (p < 0.0004) and emergency operation (p < 0.04). In aortic valve replacement, NYHA class IV (p < 0.05), prior operation (p < 0. 01) and emergency surgery (p < 0.01) were determinant. Perioperative factors of early mortality were: prolonged cross-clamping > 60 min (p < 0.02), cardiopulmonary bypass time > 90 min (p < 0.002), need for inotropic drugs (p < 0.005) and postoperative complications (p < 0.00001). Mean postoperative length of hospital stay was 12.8 +/- 8. 5 days. CONCLUSIONS: Despite the greater rate of early morbimortality in patients over 75 years of age, cardiac surgery may be performed avoiding emergency surgery, functional grade IV and prolonged length of surgery.

Age Factors↗

Competing risks in absence of independence: impact of AIDS on liver function failure mortality, and lung cancer on ischemic heart disease mortality.

The increase in lung cancer (LC) mortality can produce a decrease in mortality from other causes, including ischemic heart disease (IHD). This problem (called the competing risks problem) has been addressed usually assuming independence between the competing causes of death. Our purpose is to show that assuming dependence of causes of death allows obtaining a better estimation of cumulative mortality. We use a clinical epidemiological example on the impact of AIDS in liver function failure in a cohort of drug users. The competing effect under dependence is 47% higher than under independence. This result is compared with a population-based example on LC and IHD mortalities in Spanish people in 1992. LC and IHD share tobacco smoking as a common risk factor, so independence cannot be assumed. Under the independence assumption, both life expectancy and number of deaths from IHD are underestimated. The difference is small compared to the model computed under dependence and it occurs mainly in the elderly (0.3% more deaths in people aged 70 and over).

Acquired Immunodeficiency Syndrome↗

The butyrylcholinesterase K variant is a protective factor for sporadic Alzheimer's disease in women.

INTRODUCTION: Recent reports indicate that the K variant of the butyrylcholinesterase (BCHE) gene may act in synergism with the epsilon4 allele of apolipoprotein E (APOE) to increase the risk of Alzheimer's disease (AD), but this is controversial. MATERIAL AND METHODS: We genotyped for the BCHE-K and APOE epsilon4 alleles in a sample of 249 AD patients and 250 controls derived from the same region in a Spanish population. RESULTS: A protective effect of the K variant of BCHE with an odds ratio of 0.41 (95% confidence interval 0.19-0.86, P=0.02) was observed among non-APOE epsilon4 carriers, but it was limited to women. CONCLUSION: Our study is the first to demonstrate that lower susceptibility to AD determined by the K variant of BCHE is dependent on gender.

Aged↗

Analysis of risk factors for nosocomial sepsis in surgical patients.

BACKGROUND: This study aimed to identify patients at high risk for developing sepsis following surgery according to criteria determined by the American College of Chest Physicians and the Society of Critical Care Medicine Consensus Conference on sepsis. METHODS: A prospective case-control study was performed in surgical patients in a tertiary care centre over 1 year. Patients were identified by a daily prospective surveillance. Controls were selected randomly from the daily list of surgical inpatients. Data were collected prospectively. Crude and adjusted odds ratios (ORs) and their 95 per cent confidence intervals were computed using logistic regression analysis. RESULTS: During follow-up, 99 cases and 99 controls were identified. The main risk factors for sepsis found in the multivariate analysis were coma within 48 h before sepsis (OR 13.5, 95 per cent confidence interval 3.6-50.8), low serum albumin level at admission (OR 15.8, 5.4-46.4), two or more intrinsic co-morbidities (OR 11.8, 2.8-49.4) and parenteral nutrition (OR 5.1, 1.5-17.1). Emergency surgery (OR 3.0, 1.4-6.4), abdominal surgery (OR 2.6, 1.0-6.8) and number of surgical interventions (OR 2.5, 1. 1-6.1) were the variables related to surgery that significantly increased the risk of sepsis. Both the study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance indices showed a statistically significant trend with sepsis. CONCLUSION: Patient-related factors appear to represent the greatest risk for developing postoperative nosocomial sepsis, rather than factors associated with the surgery.

Case-Control Studies↗

Identification of weak interfaces in composites using transmission electron microscopy

A new experimental technique was developed to identify crack paths with a resolution of nanometres in fibre-reinforced composites. Cracks were introduced through Vickers indentations on one side of the sample prior to starting the thinning process. Indentations were placed close to the fibres in order to get enough cracks at the fibre/matrix interface in the electron-transparent region of the thinned sample. The technique was used in a Nicalon-fibre Al2O3 matrix composite prior to and after a heat treatment at 1200 degrees C for 1 h. The analysis of the crack paths allowed the identification of the weakest interface in each condition.

Journal Article↗

Detection of Epstein-Barr virus DNA in a patient with Kimura's disease.

An 80-year-old man, with a past medical history of senile dementia, presented with a 6-month history of a solitary, gradually enlarging tumor, located on his chin. A squamous cell carcinoma had been surgically excised 30 years previously in the same location. Physical examination revealed an erythematous, well-defined plaque of 3 cm in diameter, located on the chin (Fig. 1). The submandibular lymph nodes were enlarged. Squamous cell carcinoma and primary cutaneous lymphoma were considered. Relevant laboratory findings were as follows: white blood cell count, 5.600/microL; eosinophils, 1000/microL; gammaglobulin, 2.4 g/dL; lactate dehydrogenase, 343 IU/L; and immunoglobulin G (IgG) antibodies to Epstein-Barr virus (EBV) positive (at 1 : 128 serum dilution), with negative IgM. Skin and lymph node biopsies were performed. Histopathologic study of the cutaneous specimen revealed a heavy lymphoid infiltrate with numerous lymphoid follicles, with prominent germinal centers involving the subcutaneous fat as well as the deep dermis and muscular fascia. Some germinal centers showed folliculolysis. The lymphoid follicles were surrounded by fibrous tissue. The interfollicular infiltrate was rich in plasma cells and eosinophils that formed scattered eosinophilic microabscesses. Thin-walled vessels were numerous and prominent, but with no epithelioid or vacuolated endothelial cells (Fig. 2). Histopathology of a lymph node biopsy specimen showed reactive lymphoid follicle hyperplasia, with prominent eosinophilic infiltrates in both follicular and interfollicular areas. Eosinophilic deposits and polykaryocytes of Warthin-Finkeldey type were seen in the germinal centers. The paracortical area showed vascular proliferation. Polymerase chain reaction (PCR) for the detection of specific sequences of EBV from routinely processed paraffin-embedded material was carried out under the conditions and with the same set of primers as described previously in detail (Tenorio A, Echevarría JE, Casas E et al. J Virol Methods 1993; 44: 261-269). DNA samples were confirmed to be amplifiable with PCR primers specific for a conserved region of the human beta-globin gene. Every sample was tested at least twice for EBV DNA and beta-globin gene. One sample from one skin lesion of the patient, with confirmed diagnosis of Kimura's disease, and 10 samples from normal skin biopsies retrospectively collected from other patients in archival files of our department were tested. Only the patient's specimen tested positive to EBV. The amplified product of EBV was analyzed using DNA sequencing and confirmed the results obtained. The patient received radiotherapy at doses of 35 Gy. Nevertheless, the tumor enlarged to reach twofold its original size 1 month later. Due to the physical status of the patient, no further treatments were considered, but the disease remained stable over the following 3 years.

Aged↗

Epidemiological differences between sepsis syndrome with bacteremia and culture-negative sepsis.

OBJECTIVE: To explore the association of putative disease markers and potential risk factors with the nosocomial sepsis syndrome. DESIGN: Prospective case-control study matched for gender, age, and length of preinfection hospital stay. SETTING: 1,200-bed tertiary-care center in Spain. PATIENTS: Cases were selected using the sepsis syndrome criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference and were divided into three groups: sepsis with bacteremia (109 cases), sepsis with positive culture other than blood (122 cases), and sepsis with negative culture (115 cases without documented infection but with sepsis syndrome, clinically suspected infection, and empirical antibiotic treatment). Controls were randomly selected from the daily list of inpatients. Data were collected prospectively. Crude and multiple-risk-factor-adjusted odds ratios and their 95% confidence intervals were computed using conditional logistic regression analysis. RESULTS: Presence of coma in the 48 hours before sepsis, intensive care unit (ICU) stay, and decreased serum albumin levels at admission were common epidemiological markers identified for the three groups of cases. Having a central venous catheter was the main healthcare-related risk factor for bacteremia. ICU stay and nasogastric tube were the main risk factors for sepsis with positive culture other than blood. Coma within 48 hours before sepsis and the need of intensive care were the only two markers identified for culture-negative sepsis. CONCLUSION: Culture-negative sepsis does not behave like culture-positive sepsis, and this may imply that implementation of preventive measures to decrease the risk of bacteremia may not decrease the risk of sepsis syndrome.

Bacteremia↗

Visual manifestations of giant cell arteritis. Trends and clinical spectrum in 161 patients.

Giant cell (temporal) arteritis (GCA) is the most common systemic vasculitis in Western countries. It involves large and medium-sized vessels with predisposition to the cranial arteries in the elderly. Cranial ischemic complications, in particular permanent visual loss, constitute the most feared aspects of this vasculitis. Although the use of corticosteroids and a higher physician awareness may have contributed to a decrease in the frequency of severe ischemic complications, permanent visual loss is still present in 7%-14% of patients. To investigate further the incidence, trends, and clinical spectrum of visual manifestations in patients with GCA, we examined the features of patients with biopsy-proven GCA diagnosed at the single reference hospital for a defined population in northwestern Spain during an 18-year period. Predictive factors for the development of any visual manifestation, not only permanent visual loss, were also examined. Between 1981 and 1998, 161 patients were diagnosed with biopsy-proven GCA. Visual ischemic complications were observed in 42 (26.1%), and irreversible blindness, mainly due to anterior ischemic optic neuropathy and frequently preceded by amaurosis fugax, was found in 24 (14.9%). Despite a progressive increase in the number of new cases diagnosed, there was not a significant change in the proportion of patients with visual manifestations during the study period (p = 0.37). Patients with visual ischemic complications had lower clinical and laboratory biologic markers of inflammation. Indeed, during the last years of the study, anemia was associated with a very low risk of visual complications. Also, HLA-DRB1*04-positive patients had visual manifestations more commonly. Patients with other ischemic complications developed irreversible blindness more frequently. The best predictors of any visual complication were HLA-DRB1*04 phenotype (odds ratio [OR] 7.47) and the absence of anemia at the time of admission (OR for patients with anemia = 0.07). The best predictors of irreversible blindness (permanent visual loss) were amaurosis fugax (OR 12.63) and cerebrovascular accidents (OR 26.51). The present study supports the claim that ocular ischemic complications are still frequent in biopsy-proven GCA patients from southern Europe. The presence of other ischemic complications constitutes an alarm for the development of irreversible blindness. In contrast, a higher inflammatory response may be a protective factor against the development of cranial ischemic events.

Aged↗

[Influence of parental smoking on pediatric hospitalization for respiratory illness among children aged less than 2 years].

AIM: To determine whether parental smoking increased the risk of hospitalization among children aged less than 2 years. DESIGN: Case-reference study conducted from April 1995-May 1996. The group of cases was composed of 40% of all the children aged 2 years or less years admitted to our hospital (n=392). The reference population was composed of 15% of the live newborns in the same the hospital (n=493). The information was obtained by face-to-face interview after delivery in both populations and by telephone interview or postal survey and was completed in the reference population one year after delivery. RESULTS: Maternal smoking increased the risk of hospitalization for lower respiratory illness (adjusted RR - 1.79; 95% CI = 1.03-3.11). Moreover, the risk of hospitalization for upper or lower respiratory illness, lower respiratory illness and bronchiolitis was increased when the mother smoked more than 19 cigarettes per day. The results were adjusted for confounding factors such as prenatal age, ethnic group, maternal education, social class, breastfeeding and hospitalization of the newborn. Parental smoking, specifically maternal smoking, affects children's health, increasing the risk of hospitalization for respiratory illness in the first 2 years of life.

Hospitalization↗

Nosocomial infection, indices of intrinsic infection risk, and in-hospital mortality in general surgery.

The objectives of this paper are to assess whether two indices of intrinsic infection risk (the SENIC and the NNIS index) predict in-hospital mortality and the attributable in-hospital mortality due to nosocomial infection in surgical patients. A prospective study on 4714 patients admitted to three hospitals has been carried out. The relative risk and its 95% confidence interval (CI) were estimated. Multiple-risk factors adjusted for odds ratios (OR) were yielded by logistic regression analysis. Overall, 119 patients (2.5%) died before hospital discharge. Both the SENIC and the NNIS indices were related to in-hospital mortality in crude data. After controlling for several variables (age, sex, ASA score, cancer, renal failure, diabetes mellitus, stay at the ICU), the SENIC index did not show any significant trend with mortality (P = 0.252), whereas the trend was significant for the NNIS index (P < 0.001). Risk of death in patients with one nosocomial infection was 7.5%, and in patients developing more than one nosocomial infection was 17.1%. After adjusting for several confounding variables, the development of an organ/space surgical site infection was significantly related to mortality (OR = 4.5, 95% CI 1.5-15.6) as was blood infection (OR = 17.3, 95% CI 3.5-87.0). The association of a surgical site infection and either a respiratory tract infection or a blood infection also increased significantly the risk of in-hospital mortality (OR = 3.3, 95% CI 1.2-8.7). In conclusion, the NNIS index is a good predictor of in-hospital mortality. Patients developing an organ/space surgical site infection and/or a blood infection have an increased risk of in-hospital mortality.

Adult↗

Risk factors for monoinfections and coinfections with HIV, hepatitis B and hepatitis C viruses in northern Spanish prisoners.

A cross-sectional study was conducted in prisons of Cantabria (northern Spain) from June 1992 to December 1994. Inmates were asked to participate in a survey on prevalence and risk factors for monoinfections and coinfections with HIV, HBV and HCV. Crude and multiple odds ratios of risk factors were calculated (by polychotomous logistic regression). Prevalence of coinfections was higher than that of monoinfections. IDU risk factors were the main independent variables associated with monoinfections and coinfections with these agents. The strength of association increased with the degree of coinfection for IDU risk factors and penal status, e.g. duration of injecting drug use for more than 5 years yielded an adjusted OR ranging from 1.3 (95% CI: 0.4-5.1) for HBV monoinfection to 180 (95% CI: 61.0-540.0) for HIV-HBV-HCV coinfection. In comparison, sexual behaviours were less important than IDU risk factors.

Adult↗

Effect of SiC reinforcement on the deformation and fracture micromechanisms of Al-Li alloys

The effect of SiC reinforcement on the microstructure of a naturally aged 8090 Al alloy as well as on the deformation and fracture micromechanisms was investigated. To this end, the microstructural characteristics (grain and reinforcement morphology, precipitate structure) were determined in the unreinforced alloy and in the composite reinforced with 15 vol.% SiC particles. The materials were tested under monotonic tension and fully reversed cyclic deformation and then carefully analysed through scanning and transmission electron microscopy to find the dominant deformation and failure processes for each material and loading condition. It was found that the dispersion of the SiC particles restrained the formation of elongated grains during extrusion and inhibited the precipitation of Al3Li. As a result, the plastic deformation in the composite was homogeneous, while strain localization in slip bands was observed in the unreinforced alloy specimens tested in tension and in fatigue. The unreinforced alloy failed by transgranular shear along the slip bands during monotonic deformation, whereas fracture was initiated by grain boundary delamination, promoted by the stress concentrations induced by the slip bands, during cyclic deformation. The fracture of the composite was precipitated by the progressive fracture of the SiC reinforcements during monotonic and cyclic deformation.

Journal Article↗

The effect of frequency of chart review on the sensitivity of nosocomial infection surveillance in general surgery.

OBJECTIVE: To assess the sensitivity of different frequencies of nosocomial infection surveillance (NIS) in general surgery. DESIGN: Data obtained with a prospective daily NIS are compared with those of hypothetical cross-sectional studies carried out with different frequencies (from one weekly visit up to one visit every other day). SETTING: General surgery services at three hospitals. MAIN OUTCOME MEASURE: Sensitivity in the detection of nosocomial infection (overall and stratified by site), compared to a gold standard of prospective surveillance of every patient's complete medical record daily from the first day after surgery until discharge and once more after discharge. PATIENTS: 5,859 patients. RESULTS: 837 nosocomial infections were detected by the gold standard (58.8% were surgical-site infections [SSI]). The sensitivity of weekly NIS for all infections was 74.5% (95% confidence interval [CI95], 71.4%-77.5%) and varied from 65.1% (CI95, 56.2%-73.3%) for urinary tract infection to 83.3% (CI95, 62.6%-95.3%) for respiratory tract infection; it was 76.4% (CI95, 72.4%-80.1%) for SSI. As expected, sensitivity increased with the frequency of NIS. Performing NIS every 4 days improved sensitivity significantly, to 82.3% (CI95, 79.5%-84.8%) for all infections and 83.3% (CI95, 79.7%-86.5%) for SSI. One visit every other day increased the sensitivity for all infections by another 4.9%, mainly due to increased detection of urinary tract and other less severe infections. CONCLUSIONS: The sensitivity of two visits a week exceeded that of one weekly visit by approximately 8%, and one visit every other day added another 5% increase. Results varied according to duration of infection and postdischarge hospital stay.

Bacterial Infections↗

Increase in cervical cancer mortality in Spain, 1951-1991.

BACKGROUND: The trend in cervical cancer mortality in Spain from 1951 to 1991 is examined. METHODS: Analysis of national mortality statistics calculating age standardised mortality rates and an age-period cohort analysis. A fit to the Gompertz function was made to estimate the influence of the environmental factors on the mortality rates evolution. MAIN RESULTS: The age standardised mortality rate in Spain is lower than in other developed countries (USA or Estonia) and equal to Norwegian and Finland rates; but whereas in these countries the trend is to decrease, the Spanish rate has increased during this period, because of a cohort effect. A misclassification bias could be responsible for the trend in women aged 40 and older but the increasing trend in younger women could not be interpreted as espurious. The Gompertzian analysis suggests an increase in environmental factors causing cervical cancer. CONCLUSIONS: Cervical cancer mortality rates are increasing in Spain because of environmental factors.

Adult↗